Adjustable illuminators and methods for photodynamic therapy and diagnosis

ABSTRACT

An illuminator for photodynamically diagnosing or treating a surface includes a plurality of panels. The illuminator further includes a plurality of light sources, each mounted to one of the plurality of panels. The plurality of light sources are configured to irradiate the surface with substantially uniform intensity visible light. The illuminator also includes a heat source configured to emit heat to a patient. The heat increases the generation of a photoactivatable agent and thus shortens the time needed to complete photodynamic therapy.

CROSS-REFERENCE TO RELATED APPLICATION

This application claims the benefit of priority to U.S. ProvisionalApplication No. 62/241,902 filed on Oct. 15, 2015 and is acontinuation-in-part of U.S. patent application Ser. No. 15/292,731,filed on Oct. 13, 2016, which are hereby incorporated by reference intheir entirety.

FIELD

The present disclosure relates generally to adjustable illuminatorswhich provide a uniform distribution of visible light in a number ofconfigurations and are suitable for use in photodynamic therapy anddiagnosis, and to methods including operation of adjustableilluminators.

BACKGROUND

Photodynamic therapy (PDT), photodynamic diagnosis (PD), orphotochemotherapy is generally used to treat and/or diagnose severaltypes of ailments in or near the skin or other tissues, such as those ina body cavity. For example, PDT or PD may be used for treatment ordiagnosis of actinic keratosis of the scalp or facial areas of apatient. In addition, PDT and PD may be used for treatment and diagnosisof other indications (e.g., acne, warts, psoriasis, photo-damaged skin,and cancer) and other areas of the patient (e.g., arms and legs).

During one form of PDT or PD, a patient is first administered aphotoactivatable agent or a precursor of a photoactivatable agent thataccumulates in the tissue to be treated or diagnosed. The agent orprecursor may be administered to treat dermatological conditions, forexample. The area in which the photoactivatable agent is administered isthen exposed to visible light, which causes chemical and/or biologicalchanges in the agent. These changes allow the agent to then selectivelylocate, destroy, or alter the target tissue while, at the same time,causing only mild and reversible damage to other tissues in thetreatment area. One example of a precursor of a photoactivatable agentis 5-aminolevulinic acid (“ALA”), which is commonly used in PDT ofactinic keratosis. As used here, the terms ALA or 5-aminolevulinic acidrefer to ALA itself, precursors thereof and pharmaceutically acceptablesalts of the same.

For effective treatment, it is desirable to have a power output that isuniform in intensity and color. Illuminators, such as those disclosed inU.S. Pat. Nos. 8,758,418; 8,216,289; 8,030,836; 7,723,910; 7,190,109;6,709,446; and 6,223,071, which are incorporated by reference in theirentireties for the techniques, methods, compositions, and devicesrelated to PDT and PD, are typically used to provide the properuniformity of light for treatment purposes. These devices generallyinclude a light source (e.g., a fluorescent tube), coupling elementsthat direct, filter or otherwise conduct emitted light so that itarrives at its intended target in a usable form, and a control systemthat starts and stops the production of light when necessary.

SUMMARY

Because PDT can be used to treat a variety of treatment areas, someilluminators utilize two or more panels, each panel having a lightsource to emit light at the intended target area. These panels arecoupled together so as to be rotatable relative to each other. Byincorporating multiple, rotatable panels, the overall size and shape ofthe area that is illuminated can be changed according to the intendedtreatment area.

In conventional adjustable illuminators, the panels are equally sized bywidth and length and are typically driven at the same power level. Thepanels are further joined at their edges by hinges so as to be rotatableto achieve a desired configuration. However, due to the edges of thepanels and the presence of the hinges, the light source(s) of one paneldoes not immediately adjoin the light source(s) of an adjacent panel. Asa result, light is not emitted from a “gap” between the light sources.The lack of light emitting from such areas, together with the uniformsupply of power to the panels, can cause optical “dead space” in certainportions of the target treatment area. These portions, in turn, receiveless overall light, resulting in a lower dose of treatment in thoseportions. In some instances, the dose of treatment can be lowered by asmuch as a factor of five when compared with those areas receiving anoptimal amount of light.

Generally, these conventional illuminators are used for phototherapy ofacne, which typically does not require the administration of aphotoactivatable agent for effective treatment. Thus, exposure to thelight alone is generally sufficient treatment. Moreover, becausemultiple treatment sessions can be utilized to effectively treat thecondition, uniformity of light across the target area during a giventreatment is less of a concern in some situations. However, some formsof treatment involving PDT, such as the use of ALA to treat actinickeratosis, require specific and highly uniform intensity and color oflight to achieve effectiveness. In these instances, successful PDTrelies on the targeted delivery of both the correct quantity of thephotoactivatable agent and the correct quantity (i.e., power andwavelength) of light to produce the desired photochemical reactions inthe target cells. Thus, to achieve this, the light source must provideillumination to the target area and this illumination must be uniformwith respect to both wavelength and power. The optical dead space thatcan occur at or near the hinges of conventional adjustable illuminatorsreduces the uniformity of the light along the treatment area, therebyreducing the effectiveness of PDT for these specific treatments.Moreover, these illuminators are also configured to adjust within alimited range, such that only a limited amount of surfaces on apatient's body may be treated, such as a patient's face and scalp. Inaddition, due to the various contours of a patient's body, theuniformity of light delivered by these conventional illuminators mayvary substantially depending on the treatment area of the patient.

Therefore, it is an object of some embodiments of the present inventionto reduce or eliminate these dead spaces and provide for a more uniformlight distribution in an adjustable illuminator designed for PDT and/orPD of a variety of targeted areas. In addition, it is an object of someembodiments of the present disclosure to provide an infinitelyadjustable illuminator that can effectively deliver a uniformity oflight across various areas of a patient's body, such as a patient'sextremities (e.g., arms and legs) or torso, in addition to a patient'sface and scalp. Thus, a uniform light may be delivered to a targetedtreatment area regardless of the shape and location of the contours ofthe patient's body.

One embodiment of the present disclosure includes a plurality of panels,wherein at least one panel is of a different width than the otherpanels. This panel is positioned between two other panels and, in a way,acts as a “lighted hinge” to provide enough “fill-in” light to reduce oreliminate the optical dead spaces when the panels are bent into acertain configuration. Preferably, five panels in total may provide foran optimal increase in the total size of possible treatment areas. Twoof the panels are preferably of a smaller width than the other threelarger panels. The panels are positioned in an alternating manner suchthat each of the smaller-width panels is situated in between two of thethree larger panels to allow for both adjustability and increaseduniformity. Furthermore, to further reduce or eliminate optical deadspaces, the panels are preferably coupled together by nested hinges,thereby reducing the area in which no light source is present on theilluminator. In order to even further reduce or eliminate optical deadspaces, it is preferable that the light sources on each of the panelsare individually configurable to provide specific power output tocertain areas of the light sources on the panels to compensate fordecreased uniformity. For example, the power outputted to eachindividual diode in an array of light emitting diodes (LED) may beindividually adjusted.

One embodiment of the present disclosure relates to an illuminator forphotodynamically diagnosing or treating a surface, comprising aplurality of panels; a plurality of light sources, each mounted to oneof the plurality of panels, the plurality of light sources configured toirradiate the surface with substantially uniform intensity visiblelight; and a heat source configured to emit heat to a patient betweenouter panels of the plurality of panels.

Another embodiment of the present disclosure relates to a method ofphotodynamically diagnosing or treating a patient, comprisingcontrolling a heat source to direct heat to the skin of a patient duringa first time period; and illuminating, during a second time periodfollowing the first time period, the patient with an illuminator havinga plurality of panels to treat a dermatological condition, at least oneof the panels being provided with at least one light source.

A further embodiment of the present disclosure relates to a method ofphotodynamically diagnosing or treating a patient, comprisingilluminating the patient with an illuminator having a plurality of lightsources, and during the illumination, emitting heat from a heat sourceso as to heat the skin of the patient, wherein illumination from theplurality of light sources commences at approximately the same time asemission of heat from the heat source toward the patient.

An additional embodiment of the present disclosure relates to a systemcomprising an illuminator for photodynamically diagnosing or treating asurface, comprising a plurality of panels; a plurality of light sources,each one mounted to one of the plurality of panels, the plurality oflight sources configured to irradiate the surface with visible light;and at least one sensor configured to detect an orientation of at leastone of the plurality of panels.

BRIEF DESCRIPTION OF THE DRAWINGS

Features, aspects, and advantages of the present disclosure will becomeapparent from the following description and the accompanying exemplaryembodiments shown in the drawings, which are briefly described below.

FIGS. 1A-1B show top views of a main body of an illuminator according toan exemplary embodiment.

FIGS. 2A-2B show perspective views of the main body of the illuminatorof FIGS. 1A-1B.

FIGS. 3A-3B show detailed views of the nested hinges of the main body ofthe illuminator of FIGS. 1A-1B.

FIG. 4 shows a perspective view of the illuminator having the main bodyof FIGS. 1A-1B mounted to a stand.

FIG. 5 shows a schematic view illustrating an addressable configurationof LEDs mounted on the main body of the illuminator of FIGS. 1A-1B.

FIG. 6 shows a schematic view illustrating widths and lengths ofindividual panels of the main body of the illuminator of FIGS. 1A-1B.

FIG. 7 shows a graph illustrating light dosage across a treatment areaaccording to a conventional paneled illuminator.

FIG. 8 illustrates a graph illustrating light dosage across the sametreatment area as FIG. 7 using an illuminator according to anembodiment.

FIGS. 9A and 9B illustrate an illuminator according to an embodiment.

FIG. 9C illustrates an illuminator according to an embodiment.

FIG. 9D illustrates an illuminator according to an embodiment, in whichheat is emitted to a control volume, e.g., a cubic volume.

FIG. 9E depicts a control volume according to an embodiment.

FIG. 9F is a perspective view showing a configuration according to anembodiment.

FIG. 10 illustrates a cubic volume at which a plurality of nodes aredefined.

FIGS. 11A-B illustrate thermal data according to an embodiment.

FIGS. 12A-D illustrate thermal data without application of light.

FIGS. 13A-D illustrate thermal data without application of heat.

FIGS. 14A-D illustrate thermal data on a nodal basis, according to anembodiment.

DETAILED DESCRIPTION

Various embodiments are described hereinafter. It should be noted thatthe specific embodiments are not intended as an exhaustive descriptionor as a limitation to the broader aspects discussed herein. One aspectdescribed in conjunction with a particular embodiment is not limited tothat embodiment and can be practiced with any other embodiment(s).

As will be understood by one of skill in the art, for any and allpurposes, particularly in terms of providing a written description, allranges disclosed herein also encompass any and all possible subrangesand combinations of subranges thereof. Any listed range can be easilyrecognized as sufficiently describing and enabling the same range beingbroken down into at least equal halves, thirds, quarters, fifths,tenths, etc. As a non-limiting example, each range discussed herein canbe readily broken down into a lower third, middle third and upper third,etc. As will also be understood by one skilled in the art all languagesuch as “up to,” “at least,” “greater than,” “less than,” and the likeinclude the number recited and refer to ranges which can be subsequentlybroken down into subranges as discussed above. Finally, as will beunderstood by one skilled in the art, a range includes each individualmember.

Unless otherwise indicated, all numbers expressing quantities ofproperties, parameters, conditions, and so forth, used in thespecification and claims are to be understood as being modified in allinstances by the term “about.” Accordingly, unless indicated to thecontrary, the numerical parameters set forth in the followingspecification and attached claims are approximations. Any numericalparameter should at least be construed in light of the number reportedsignificant digits and by applying ordinary rounding techniques. Theterm “about” when used before a numerical designation, e.g.,temperature, time, dosage, and amount, including range, indicatesapproximations which may vary by (+) or (−) 10%, 5% or 1%.

FIGS. 1A-1B and 2A-2B illustrate an embodiment of a configurableilluminator according to the present disclosure. The illuminatorincludes a main body 100, which preferably has five individual panels 10a-10 e, each of which are connected in a rotatable manner via nestedhinges 50. Each panel contains an array of light emitting diodes (LED)60, which may be configured in an evenly spaced pattern across the faceof the panel. The number of individual LEDs arranged in a given array isnot particularly limited. Alternatively, other types of light sourcesmay be used, such as fluorescent or halogen lamps.

Preferably, each LED array 60 extends as far to the edges as possible.In addition, the LED arrays 60 are preferably dimensioned to provide anoverall lighted area for a given treatment area based on a range fromthe 5th percentile of corresponding sizes of female subjects to the 95thpercentile of corresponding sizes of male subjects for that particulartreatment area. The LED arrays 60 emit light at an appropriatewavelength according to the intended treatment or to activate theparticular photoactivatable agent used in treatment or diagnosis. Forexample, when ALA is used as a precursor of a photoactivatable agent forthe treatment of actinic keratosis, the LED arrays 60 preferably emitblue light having wavelengths at or above 400 nanometers (nm), forexample, about 430 nm, about 420 nm or, for example, 417 nm. However,the LED arrays 60 may also emit visible light in other ranges of thespectrum, such as in the green and/or red ranges between 400 and 700 nm,for example, about 625 nm to 640 nm or, for example, 635 nm. Forexample, the LED arrays 60 may also emit light having wavelengths of 510nm, 540 nm, 575 nm, 630 nm, or 635 nm. In addition, the LED arrays 60may be configured to emit light continuously or the LED arrays 60 may beconfigured to flash the diodes on and off based on a predeterminedinterval. Furthermore, the LED arrays 60 may be configured such thatonly one wavelength of light (e.g., blue) is emitted. Alternatively, theLED arrays 60 may be configured such that two or more wavelengths oflight are emitted from the arrays. For example, the LED arrays 60 may beconfigured to alternately emit blue light and red light for treatmentpurposes.

As shown in FIGS. 1A-1B and 2A-2B, the five panels 10 a-10 e are ofdifferent widths relative to one another. In particular, in certainembodiments, three panels 10 a, 10 c, 10 e are configured to have widerwidths, while two panels 10 b, 10 d have smaller, narrower widths, eachof the narrower widths of the two panels 10 b, 10 d being less than eachof the wider widths of the three panels 10 a, 10 c, 10 e. In someembodiments, the wider widths of the three larger panels 10 a, 10 c, 10e are approximately equal. In other embodiments, the wider widths of thethree larger panels 10 a, 10 c, 10 e are different relative to oneanother. In addition, the narrower widths of the two panels 10 b, 10 dmay be approximately equal or may be different relative to one another.The panels are further arranged in an alternating configuration, withthe narrower panels (e.g., 10 b) positioned in between two wider panels(e.g., 10 a, 10 c). As shown in FIG. 6, in some embodiments, thenarrower panels 10 b, 10 d are configured to have a width that is about30% to 60% less than the width of the wider panels 10 a, 10 c, 10 e. Inother embodiments, the narrower panels 10 b, 10 d are configured to havea width that is about 30% to 50% less than the width of the wider panels10 a, 10 c, 10 e.

As shown in FIGS. 1A-1B and 2A-2B, the panels 10 a-10 e are rotatablyconnected by hinges 50. The hinges 50 may take the form of nestedhinges, which may include hinges that substantially reduce or eliminateoptical dead spaces. As shown in FIGS. 2A-2B, on at least one side of apanel, a tab 23 may extend out from both the top and bottom of thepanel. The tabs 23 are configured such that a side of an adjacent panelmay be received between the tabs 23, as shown in FIG. 2A. Thus, as seenin FIGS. 2A-2B and 6, the height of the adjacent panel (e.g., panel 10a) is slightly smaller than the height of the tabbed panel (e.g., panel10 b) into which the adjacent panel is received. As shown in FIG. 6, themiddle panel (i.e., panel 10 c) is preferably configured as having thelargest height, such that it is tabbed on both sides and may receive thesides of adjacent panels on each side. As seen in FIGS. 1A-1B, each ofthe tabs 23 further includes an opening to receive a bolt to connectadjacent panels together.

The panels 10 a-10 e may be arranged such that side panels can move soas to expand a total footprint or coverage area of the panels 10 a-10 e,and may be configured to extend to portions of a patient such as thepatient's chest or stomach. In at least one embodiment, at least one ofthe panels 10 a-10 e may be arranged such that at least one of thepanels is provided in a flat or folded (bent or angled, for example)arrangement. The panels may be moved in a continuously variable manner.In at least one embodiment, one or more of the panels is provided withone or more detent mechanisms to retain the one or more panels in adesired position. The one or more detent mechanisms may be provided withthe one or more panels such that the movement of the panels isrestrained by the detent mechanisms to achieve a plurality of distinctpanel configurations for treatment, in which the panels are kept in aspecific position while a patient is being treated. The panels may bearranged relative to each other so as to achieve one or more particularconfigurations of the illuminator. In at least one embodiment, thepanels may be arranged relative to each other such that the illuminatorachieves at least one of a curved, flat or folded configuration, forexample.

As shown in further detail in FIGS. 3A-3B, between the tabs 23 are thenested hinges 50, which are mounted to the inner side surfaces ofadjacent panels (e.g., 10 a, 10 b) to allow for rotation of the panels.A flange 51 of the hinge 50 is mounted to the inner side surface of apanel via bolts 53. The inner side surface of a panel may include arecess in which the flange 51 may be placed. The inner side surface ofthe panel may also include an additional recess to accommodate the jointof the hinge 50 such that the joint of the hinge 50 becomessubstantially flush with an outer front surface of the panel. Suchconfigurations may allow for the outside vertical edges of adjoiningpanels to be positioned closer to one another. By spacing the verticaledges of adjoining panels closer, optical dead spaces may be furtherreduced or eliminated. In addition, the hinges 50 together with the tabs23 may reduce the number of pinch points present in the system.

As shown in FIGS. 1A-1B, the main body 100 of the illuminator mayinclude a mounting head 40. The mounting head 40 may allow for the mainbody 100 to be mounted to a movable stand 80, which is shown in FIG. 4,to allow a user to easily move the main body 100 to the appropriatetreatment position. The stand 80 includes a base 81 and a verticalpillar 82. The base 81 may further include wheels 87 at its bottom inorder to allow the user to horizontally move the illuminator to anappropriate position. The wheels 87 may include locks, such that thestand 80 is prevented from further horizontal movement once positioned.In addition, the vertical pillar 82 may be attached to the base 81 at apivot point 83. The pivot point 83 allows the vertical pillar 82 to berotated to increase the range of positioning for the illuminator. At atop end, the vertical pillar 82 includes a connecting arm 85, which mayserve as a mounting structure for the main body 100. The connecting arm85 includes a hinge point 86 such that the main body 100 can be movedvertically relative to the stand 80. The vertical pillar 82 may also beconfigured as a telescopic structure, such that the user can change theheight of the vertical pillar 82. This allows for an increased range ofvertical movement for the main body 100, which can allow the user toposition the main body 100 at lower portions of a treatment area, suchas a patient's legs or feet. The stand 80 may also include astabilization arm 84. Once the stand 80 and main body 100 is positioned,the stabilization arm 84 may be attached to the main body 100 to preventunwanted movement of the main body 100 during treatment. As furthershown in FIG. 4, a controller and power supply 90 is mounted to thestand 80 in order to supply electrical power to the main body 100 andallow the user to control the main body 100 for treatment purposes.Alternatively, the controller and power supply 90 may be directlymounted to the main body 100. In order to provide a cooling system forthe LED arrays 60, one or more fans 70 may be mounted onto each of thepanels, as shown in FIG. 4.

At least one controller (also referred to as a control unit) is alsoconnected to the panels to regulate power to the lights to achieve therequired uniformity and intensity for the target treatment. In at leastone embodiment, the controller may also control output of a heat source160 discussed in more detail below. In at least one embodiment, theremay be a plurality of controllers controlling at least one dynamicprocess, e.g., controlling output(s) of one or more of: one or morelight sources, one or more heat sources, and/or one or more air sources(such as a fan), in any combination. For example, separate controllersor integrated controllers may be provided for respectively controllingthe output of LED arrays 60 and the heat source 160. In at least oneembodiment, a first controller may control both light and heat sources,and a second controller may control an air source, for example.

The controller may be implemented as hardware, software, or acombination of both, such as a memory device storing a computer programand a processor to execute the program. Alternatively, each panel mayhave a dedicated controller to regulate power to the individual LEDarray on a given panel to allow for more particular calibration of theilluminator, which may further enhance uniformity and increaseefficiency. For example, under Lambert's cosine law, light intensity ata given point on a “Lambertian” surface (such as skin) is directlyproportional to the cosine of the angle between the incoming ray oflight and the normal to the surface. Thus, a ray of light that isdirected to the front of a curved surface (e.g., a head of a patient)will arrive in a substantially perpendicular manner to that area andwill result in 100% absorbance. However, a ray of light that arrives ata side edge of the curved surface will arrive in a substantiallyparallel manner. According to Lambert's cosine law, the intensity, andthus absorption, of the light at the side edge will approach zero,making treatment at that area ineffective. Thus, a “fall off” of lightexposure tends to occur at the edges of a curved surface. In addition,“fall off” increases as the distance between the light source and thepoint on the surface increases.

Configuring an illuminator to conform to the curved surface (e.g., aU-shaped configuration designed to “wrap around” the curvature of thesurface) aids in reducing this effect and increases overall uniformity.However, to sufficiently increase uniformity, the light source should belarger relative to the target treatment area in order to fully encompassthe body part to be treated and also provide light from all angles toany target point on the treatment area. In order to increase theuniformity of light exposure to the treatment area while maintaining apractical size of the illuminator, the LED arrays 60 may be individuallyconfigured to increase the intensity of light emitting from certaindiodes to compensate for this fall-off effect.

An example in which the LED arrays 60 may be individually configured isshown in FIG. 5. Here, the LED arrays 60 are divided into three generalareas, which may be described as “addressable strings.” Areas 1, 3, and5 correspond to an addressable string configuration that may be includedin the wider panels 10 a, 10 c, and 10 e, while areas 2, 4, and 6correspond to an addressable string configuration that may be includedin the narrower panels 10 b and 10 d. The current to each area isadjusted in order to adjust the intensity of light emitting from each ofthe areas. For example, a higher current may be supplied to areas 1 and2 than the current supplied to areas 3 and 4 such that areas 1 and 2emit a higher intensity of light than areas 3 and 4. Similarly, a highercurrent may be supplied to areas 3 and 4 than the current supplied toareas 5 and 6. Thus, a higher intensity of light is emitted overall fromthe edges, which may allow for a reduction in any fall-off effect.Alternatively, the illuminator may be configured to adjust eachindividual diode present in a given LED array 60, allowing for an evengreater calibration effect (that is, fine tuning).

Furthermore, by using either pre-programmed settings or sensors todetect the curvature of the surface to be treated, the LED arrays 60 canbe individually configured to emit more intense light to only thoseareas that require it. Additionally, pre-programmed sensors can be usedto detect the orientation of one or more panels (e.g., whether a panelis curved or folded flat) and may be used to configure the LED arrays 60to emit more or less intense light in areas that require it. Inparticular, in at least one embodiment, at least one sensor detects anorientation of at least one panel and provides detection information (adetection result) to the controller. The sensors may include one or moreencoders, such as one or more angle encoders, which are provided at oneor more locations on the panels. In at least one embodiment, at leastone sensor is a microswitch configured to sense a position of at leastone panel. In some embodiments, a plurality of sensors may include anencoder, a microswitch, or combinations thereof. The sensors arecommunicated with the controller and are configured to provideinformation about the panel orientation, such as an angle at which apanel is disposed, to the controller. The controller then controls theintensity of light in accordance with a detection result. In at leastone embodiment, a plurality of sensors provides information to thecontroller so that the controller may carry out a determination as towhether the illuminator has a configuration that is one of a pluralityof preset configurations. For example, the controller may store, in amemory, information relating to one or more preset configurations (e.g.,for a bent illuminator, a flat illuminator, etc.).

When the controller receives information transmitted from the sensors,the controller may compare the sensed information to the presetconfigurations to determine a match between the sensed information andone or more preset configurations. The controller may further store aprotocol for altering intensity which is executed upon determining amatch between the sensed information and the preset configuration. Forexample, if the illuminator is detected to be a curved illuminator, thecontroller implements a light intensity output which is correlated tothe preset protocol for a curved illuminator. The controller may furthercompare an existing intensity to an intensity associated with aparticular configuration and determine whether the intensity should beadjusted. This allows for an increase in uniformity of light exposure inan efficient manner as power output and/or light intensity is increasedto only certain diodes, in accordance with need. In at least oneembodiment, a plurality of preset configurations may be presented to aclinician or practitioner, e.g., on a touch screen, who may then selectthe preset configuration corresponding to the physical arrangement ofthe illuminator in the clinical environment.

The addressable strings of the LED arrays 60 may also include varyingamounts of individual diodes mounted within the particular area. Forexample, for the wider panels 10 a, 10 c, and 10 e, 12 diodes may bemounted in each of areas 1, while 9 diodes may be mounted in each ofareas 3, and 41 diodes may be mounted in area 5, resulting in a total of83 individual diodes included within each of the wider panels 10 a, 10c, and 10 e. For the narrower panels 10 b and 10 d, 8 diodes may bemounted in each of areas 2, while 9 diodes may be mounted in each ofareas 4, and 23 diodes may be mounted in area 6, resulting in a total of57 individual diodes included within each of the narrower panels 10 band 10 d. However, the number and arrangement of diodes included withineach of the LED arrays 60 is not particularly limited. For example, thewider panels 10 a, 10 c, and 10 e may each contain a total amount ofdiodes that ranges from about 80 diodes to about 350 diodes. Similarly,the narrower panels 10 b and 10 d may each contain a total amount ofdiodes that ranges from about 50 diodes to about 250 diodes. By varyingthe arrangement of the diodes within each of the addressable strings ofthe LED arrays 60, power output and/or the intensity of light emittedfrom a given array may be better controlled and fine-tuned.

In addition, individually regulating power to the LED arrays 60 can alsocontribute to the reduction or elimination of the optical dead spacesthat may otherwise occur at the hinge points. Specifically, power outputand/or the emitted light intensity may be increased close to the edgesof the array that are closest to the nested hinges to compensate for thelack of light emitting from the meeting point of panels. The narrowerpanels 10 b, 10 d are also preferably operated at a higher power leveland/or at a higher emitted light intensity compared to the wider panels10 a, 10 c, 10 e in order to provide additional fill-in light.Furthermore, individual power regulation may aid in compensating formanufacturing variance that can occur in individual diodes. Finally, byfine-tuning each array 60, the panels can be easily deployed for otherapplications as each array is specifically configurable to address thelighting needs of the specific application.

The illuminator may further include a timer, which can indicate to theuser the appropriate length of exposure time for the particulartreatment. The illuminator may also be programmed with pre-stored lightdosing parameters to allow the user to select a desired treatment type.The pre-stored parameters may include, for example, pre-stored settingsfor exposure time, light intensity, and outputted wavelength. Based onthe selected treatment, the illuminator is automatically configured toprovide the correct lighting dosage by being supplied with theappropriate power output to achieve the required uniformity for thetreatment. Alternatively, the illuminator can be provided with sensorsthat detect the size of the treatment area positioned in front of theilluminator. The sensors then determine the correct light dosingparameters based on the sensed treatment area. The illuminator may alsofurther include actuators and may be programmed to be movedautomatically depending on the selected treatment. Once a treatment isselected, the illuminator may be automatically positioned into theproper configuration by the actuators without requiring the user to movethe system by hand. Alternatively, the sensors may detect the adjustedposition of the illuminator manually set by the user. The detectedposition of the illuminator may then be used to indicate the intendedtreatment area. Correct light dosing parameters for the specifictreatment area may then be provided based on the detected position setby the user.

The illuminator of the present disclosure allows for an infinite amountof configurations that can be adapted for the targeted treatment area.The configurations may range from a flat-plane emitter (as shown inFIGS. 1B and 2B) to a substantially U-shaped configuration (as shown inFIGS. 1A and 2A). The adjustable illuminator may also be configured suchthat the two end panels 10 a, 10 e can be pulled back relative to thethree middle panels 10 b, 10 c, 10 d, such that a smaller U-shapedconfiguration may be created by the middle panels. Thus, the adjustableilluminator allows for the treatment of additional areas of a patient'sbody. In other words, not only can the adjustable illuminatoreffectively deliver a uniform light intensity to traditional surfacessuch as the face or scalp, but the adjustable illuminator can alsoprovide a device that can easily be configured to treat other portionsof a patient's body, in particular, those having smaller curvedsurfaces, such as the arms and legs. Moreover, the adjustableilluminator may also be easily positioned to deliver a uniform lightintensity to larger treatment areas, such as the back or chest.

As described above, the narrower panels 10 b, 10 d are dimensioned suchthat the panels act as “lighted hinges.” Thus, when the wider panels 10a, 10 c, 10 e are adjusted into the desired form, the illuminator“bends” at the narrower panels 10 b, 10 d, where traditionally the“bend” would occur substantially at the hinge itself. Thus, instead ofan unlighted “bent” portion as would occur in the conventionalilluminator, the present illuminator provides a “bent” portion that isalso configured to emit light, thereby helping to reduce optical deadspace without requiring large amounts of power differentiation among thelight sources of each panel to provide the required fill-in light. Theeffects of this configuration can be best seen in a comparison of FIGS.7 and 8. FIG. 7 illustrates the light uniformity produced by aconventional illuminator, measured with a cosine response detector,which mimics the response of a patient's skin to the incident of lightas described above, at a distance of two inches. Total light dose, interms of J/cm², was measured based on emitted irradiance (W/cm²) overtime (in seconds). The targeted treatment area shown is a patient'shead, where height is shown as the y-axis and rotation angle from thecenter of the emitting surface is shown as the x-axis. As can be seen inFIG. 7, higher light doses of about 10 J/cm² occur at the center of theface (for example, at region A), near the patient's nose, where thepatient is facing closest to, and substantially perpendicular to, themiddle-most panel. Total light dose then begins to drop as movement awayfrom the center of the face occurs where the effects of cosine“fall-off” and optical dead spaces are more prevalent. For example,light dose is reduced by about 20% at the patient's cheek areas (forexample, at region B), and by about 80% toward the outer boundaries ofthe patient's face (for example, at region E), such as the ears andforehead. Thus, as shown in FIG. 7, conventional adjustable illuminatorsutilizing equally-sized panels operating at the same power output levelproduce a varying field of light uniformity, making it undesirable andineffective for those treatments requiring highly specific lightuniformity.

While certain embodiments described above relate to an illuminatorcomprising a plurality of panels, other embodiments may include anarcuate illuminator without individual rectilinear panels. For example,in at least one embodiment, the illuminator may be constructed of atleast one curvilinear member. Further, the arcuate illuminator may havesubstantially curved portions extending from a substantially flatportion provided between the substantially curved portion. The patient'sface may be positioned so as to be opposed to the substantially flatportion, such that at least three sides of the patient's head aresurrounded by the illuminator. For example, the patient's face may bedirectly opposed to a first portion of the illuminator, while the leftand right sides of the patient's head may be opposed to second and thirdportions, respectively.

FIG. 8, on the other hand, illustrates the light uniformity produced byan embodiment of the present disclosure. The targeted treatment area isthe same as that measured in FIG. 7. However, compared to FIG. 7, thelight output uniformity produced by the illuminator is greatly enhancedacross the patient's face and exhibits little to no deviation from thelight output measured in the center of the patient's face to the lightoutput measured at the edges of the patient's face. For example, asshown in FIG. 8, total light doses of about 10 J/cm² (for example, atregion A′) are provided across all regions of the face, including thecenter of the face (for example, the patient's nose), the patient'scheck areas, and the outer boundaries of the patient's cheek areas, suchas the ears and forehead. Moreover, total light dose drops off minimally(for example, at region B′) at the extreme outer boundaries of thepatient's face. In one embodiment, the measured output over an activeemitting area (over the entire active emitting area) is within 60% ofthe measured maximum (over the entire active emitting area) measuredwith a cosine response detector over all operation distances. Morepreferably, the measured output over the emitting area is within 70% ofthe measured maximum over a distance of two and four inches. Even morepreferably, the measured output over the emitting area is within 80% ofthe measured maximum over a distance of two and four inches.

One example of a treatment method for precancerous lesions, such asactinic keratosis, by PDT utilizing an adjustable illuminator describedabove in conjunction with ALA will now be described.

Essentially anhydrous ALA is admixed with a liquid diluent just prior toits use. The ALA admixture is topically applied to the lesions using apoint applicator to control dispersion of the ALA admixture. Theadmixture may be applied in accordance with the techniques disclosed inU.S. patent application Ser. No. 15/371,363, filed on Dec. 7, 2016,which is hereby incorporated by reference in its entirety for thebackground, apparatuses and methods described therein. After the initialapplication of the ALA admixture has dried, one or more subsequentapplications may be similarly applied. Approximately 10-20% solution ofALA is administered. Formation of photosensitive porphyrin andphotosensitization of the treated lesions occurs over the next ½-18hours, during which time exposure to direct sunlight or other brightlight sources should be minimized. Between ½ and 18 hours afteradministration of the ALA, the lesions are irradiated by the adjustableilluminator according to the present disclosure. The illuminatorirradiates the lesions with a uniform blue light for a prescribedperiod. According to a preferred treatment, the visible light has anominal wavelength of 417 nm.

Such embodiments thus provide a method for photodynamically diagnosingor treating a contoured surface of a patient, which includes providingthe adjustable illuminator described above, placing the patient in theilluminator, and illuminating the patient to diagnose or treat thepatient. The patient may be illuminated to treat actinic keratosis,acne, photo-damaged skin, cancer, warts, psoriasis, or otherdermatological conditions. The method may also be used to remove hairand diagnose and treat cancer.

Since the total light dose (J/cm²) is equal to irradiance (W/cm²)multiplied by time (sec), one parameter that needs to be controlled fordelivery of the correct treatment light dose is exposure time. This maybe accomplished by the timer described above, which can control theelectrical power supplied to the LED arrays 60 appropriately, and whichcan be set by the physician. Data has shown that 10 J/cm² delivered froma source with an irradiance density of 10 mW/cm², or an irradiancedensity of about 9.3 to about 10.7 mW/cm², produces clinicallyacceptable results for desired treatment areas (e.g., face, scalp,extremities). From the equation above, this light dose will require anexposure time of 1000 seconds (16 min., 40 sec). In addition, due to theaddressable nature of the adjustable illuminator, the illuminator may beused to treat a patient at higher power such that less time is requiredfor effective treatment. For example, the adjustable illuminator maydeliver an irradiance density of 20 mW/cm² for an exposure time of 500seconds (8 min. 20 sec) to deliver a clinically acceptable light dose of10 J/cm². Alternatively, the adjustable illuminator may include higherpower ranges, such as 30 mW/cm², over an exposure time resulting in alight dose of 10 J/cm². A selected light dose may also be administeredby additionally or alternatively varying the irradiance density overtreatment time. In at least one embodiment, a parameter which iscontrolled is the temperature to which the illuminator is heated, asdiscussed below.

According to one embodiment, a method of treatment includes warming upan illuminator so as to cause heat to be emitted from the illuminator,and exposing a patient's skin to the illuminator. The heat acceleratesthe conversion of the ALA to porphyrin (e.g., photosensitive porphyrinor proto porphyrin). The relationship between temperature exposure andALA conversion is non-linear, and the enzymatic pathways responsible forthe conversion are highly sensitive to temperature. In at least oneembodiment, increasing the temperature by approximately 2° C. mayapproximately double the rate of production of protoporphyrin IX (PpIX),for example. In at least one embodiment, increasing the heat output ofthe illuminator, e.g. by approximately 2° C., may produce an effectafter about 20 minutes of treatment which is comparable to that realizedover the course of 1-3 hours of treatment, without increasedtemperature.

In particular, a method according to one embodiment includes turning ona light such as LEDs 60, and turning on a heating element of theilluminator. The method may include turning on both the LEDS 60 and theheating element simultaneously, such that light and heat are bothapplied during a treatment period. The method may further includeturning on the LEDs 60 after a period in which the heater heats up(e.g., a 5 minute warm-up period). For a treatment period of about 20minutes, the total acceptable light dose delivered to the patient may beapproximately 10-20 J/cm². The treatment period in an exemplaryembodiment may be from about 10 minutes to about 1 hour. The totalacceptable light dose in an exemplary embodiment may be about 10-40J/cm². In at least one embodiment, the treatment period may be longerthan 1 hour or shorter than ten minutes, and the acceptable light dosemay be less than 10 J/cm² or more than 40 J/cm², depending on theclinical circumstances.

In at least one embodiment, the LEDS 60 and a heating element (a heatsource) 160 may not be turned on simultaneously, but in a consecutivemanner. For example, first, the ALA may be applied. Next, the heatingelement may be activated, to apply heat to the patient's skin for afirst treatment period for a thermal soak, which may be 20-30 minutes,for example. It has been found that the surface temperature of a facewill stabilize in about 5 minutes. Following the first treatment period,light may be applied for a second treatment period, e.g., about 8-15minutes. The total light dose delivered to the patient may beapproximately 10-20 J/cm². In some embodiments, at least a portion ofthe heat may be delivered through one or more heating pads positioned ona patient's skin. In at least one embodiment, such a process is carriedout for treating a dermatological condition of the patient, for example.The treatment period in an exemplary embodiment may be from about 10minutes to about 1 hour. The total acceptable light dose in an exemplaryembodiment may be about 10-40 J/cm². In at least one embodiment, thetreatment period may be longer than 1 hour or shorter than ten minutes,while the acceptable light dose may be less than 10 J/cm² or more than40 J/cm², depending on the clinical circumstances.

Additionally, in at least one embodiment, a method of treatment furtherincludes recording data indicative of temperature for at least one nodein a volume, and recording data indicative of temperature for at leastone additional node in the volume. The volume may be a control volume ofcubic or other form corresponding at least in part to a portion of thepatient's skin which is exposed to the illuminator.

FIGS. 9A and 9B illustrate an apparatus according to an embodiment ofthe present disclosure. The apparatus is an illuminator includingcertain components shown, for example, in FIGS. 2A-2B. The illuminatorincludes a frame 150 into which panels 10 a-10 e are assembled. Inaddition to the panels 10 a-10 e, a heat source (heating element) 160 isassembled in the frame 150. For example, as shown in FIG. 9B, the heatsource 160 may be sandwiched between panels 10 b, 10 d and positioned atleast partially behind panel 10 c. The heat source 160 may includecurved terminal portions 162, 164 which project beyond the panels, suchthat at least a portion of the heat source is not obstructed by thepanels and is directly exposed to the patient. In at least oneembodiment, the heat source 160 may be an infrared quartz heater.Together the panels 10 a-10 e, frame 150, and portions 162, 164 create apartially enclosed space which retains a bath of warm air into which aportion of the patient (e.g., the patient's head) may be immersed.

In at least one embodiment, the heat source 160 may comprise framemounted resistance tape heaters. In at least one embodiment, the heatsource 160 may comprise a plurality of heaters, including at least oneselected from the group including IR LEDs, resistance cartridge heaters,positive temperature coefficient heaters, or IR quartz heaters, asmentioned above. In at least one embodiment, the IR quartz heater isrelatively responsive and produces a sufficient heat output, and may bereadily controlled, e.g., by a controller 77, which may be aproportional integral derivative (PID) controller. Further, the IRquartz heater is relatively compact and may be integrated into the frame150 without requiring enlargement of the frame 150.

The heat source 160 may be equipped with at least one controller (acontrol unit), such as the controller 77 to heat output to the targettreatment. The control unit may be a controller implemented as hardware,software, or a combination of both, such as a memory device storing acomputer program and a processor to execute the program. In at least oneembodiment, the heat source 160 is controlled by a PID controller withmonitoring and over/under temperature limit control. In someembodiments, the controller may further include one or more of aninput/output (I/O) expansion module and a data logging and fieldcommunications access module. The controller may be a microprocessorregulator with software framework drivers programmed to control an inputset temperature to a specified tolerance based on feedback from areference control thermistor 170 discussed below. In at least oneembodiment, the heat source is configured to output sufficient heat toreach a predetermined skin or tissue temperature target, e.g., 40° C.±2°C.

FIG. 9C illustrates an illuminator according to an embodiment. In atleast one embodiment, the illuminator further includes one or morethermistors. The thermistors may be integrated into the illuminator orprovided in a kit including a suite of diagnostic tools. In at least oneembodiment, a negative temperature coefficient or a positive temperaturecoefficient thermistor may be provided as a reference control thermistor170 disposed on or near the heat source 160. In at least one embodiment,the thermistor 170 may be arranged at a portion of the heat source 160proximate to an upper portion of panel 10 c. A temperature measured bythe reference control thermistor 170 may be compared to a temperaturemeasured at the exposed skin of the patient, e.g., by a temperatureprobe placed on the patient's forehead, such as a contact thermocouple.In some embodiments, one or more thermocouples may be used to ascertaina relationship between the skin temperature (thermocouple temperature)and a temperature sensed by thermistor 170 (a control temperature orthermistor temperature).

In particular, the one or more thermocouples may be used to ascertain arelationship between skin temperature and control temperatures when theilluminator is originally manufactured, or when a first diagnosis iscarried out. For example, a reference or control temperature may be setbased on experimentally derived data, and a reference or controltemperature against which the thermocouple temperature is compared maybe temperature value from a table stored in a memory of a control unitconnected to the illuminator. In at least one embodiment, the thermistormay be a programmable thermistor in which one or more temperature valuesare stored, and after the thermistor is programmed, it may be used toregulate the heat output of heat source 160. The comparison oftemperatures may be carried out at one or more locations across theexposed skin of the patient. For example, by carrying out temperaturemeasurement at a plurality of locations across the patient's face, athermal map of the patient's face may be constructed. A thermal mappingmay be performed before and after treatment. Further, the results of thethermal mapping may be compared, e.g., to a user's needs as articulatedin a treatment or clinical plan. The results of a patient's thermalmapping may be compared to one or more other patient's thermal mappingdata.

In at least one embodiment, the heat source 160 may be used inconjunction with fans 70. For example, the fans 70 may be operated tocirculate cooling air through the system. Further, cool air or roomtemperature air, which travels along a path indicated by arrows labeled‘C’ in FIG. 9C, may be directed toward a heat exchanger in the heatsource 160. The heat exchanger heats the cool air. The heated air, whichtravels along a path indicated by arrows labeled ‘H’ in FIG. 9C, may beblown at relatively gentle flow rates. In at least one embodiment, thefans 70 are controlled by a controller to provide an air speed ofapproximately 3-6 knots and a volumetric flow rate of 14 cubic feet perminute (CFM). In some embodiments, the fan speed may be constant orvariable. In at least one embodiment, a controller (which may be acontroller that controls at least one of the LEDs 60 or heat source 160)controls the fans 70. The controller may control the output of one ormore of fans 70 by varying the revolutions per minute (RPM) of fans 70,for example. The heated air may be blown by fans 70 toward the face ofthe patient, e.g., from a top and bottom of the heat source 160. The airflow creates a bath or pocket of heated air which substantially aroundthe patient's skin, such that the patient's face, for example, may beenveloped in warm air. The thermodynamic behavior of the system mayallow for controlling the disparity between the temperature at thepatient's skin (measured with the contact thermocouple) and thetemperature measured by the thermistor, so as to be within about 15° C.,for example. In at least one embodiment, the surface of the patient'sskin (e.g., their facial skin) attains a stable temperature within fiveminutes of when the heat from the heat source 160 is emitted.

Control of the thermodynamic transfer behavior allows for the air thatis being blown and the heat output by the heat source to be modulated inaccordance with a desired heating effect of the skin. In at least oneembodiment, a desired raise in skin temperature (e.g., by 2° C.) may beachieved by determining a rise in air temperature and a correspondingtime period. That is, the controller may be programmed to determine howhigh and for how long the temperature should be raised in order to heata patient's skin to a desired level. Further, in at least oneembodiment, the controller may also make such a determination withrespect to air speed and/or volumetric flow rate. Such determinations bythe controller may be made with reference to one or more maps stored inthe memory of the controller. For example, one such map is a mapcorrelating the temperature of thermistor 170 to a rise in skintemperature. Another such map is a map correlating the thermistortemperature to the air speed and the volumetric flow rate of the air.The air speed and volumetric flow rate themselves vary at least in partbased on the configuration of heat source 160, and more particularly,how the curved portions (plenums) 162, 164 are structured and arranged.In at least one embodiment, the one or more maps stored in memory maycorrelate one or more of the thermistor temperature, a desired skintemperature, a volumetric flow rate, an air speed, and an airtemperature to each other. The controller may reference information fromone or more such maps to carry out a precise control of skintemperature. The system may be provided with a plurality of sensors forsensing temperature at a plurality of locations, and the controller mayreference the aforementioned maps containing data from such sensors tocontrol the heat source 160 at one or more locations. Further, by takinginto account information from the thermal heat maps, heating of the skinat multiple points may be controlled in accordance with a treatmentplan. In one embodiment, the use of such map allows the desired skintemperature to be obtained without directly measuring the skintemperature by one or more temperature sensors on the skin, for example.

FIG. 9D illustrates an illuminator according to an embodiment, in whichheat is emitted to a control volume, e.g., a cubic volume. In at leastone embodiment, the heat source 160 may emit heat to a treatment target,such as a target within a cubic volume 172 as shown in FIG. 9D. Thecubic volume 172 may have a total height of 6″, and the temperature maybe measured at a plurality of points in the x, y and z directions of thecubic volume 172. For example, the temperature may be sensed at 3″ froma center panel 10 c, where a predetermined treatment target is disposedat a center of the cubic volume 172. FIG. 9E depicts the cubic volume172 wherein a treatment target is a patient's nose, centered in thevolume. FIG. 9F is a perspective view showing an exemplary positioningof a patient with respect to the heat source 160 and illuminator.

FIG. 10 illustrates a volume with respect to which nodes 1-12 may bedefined, with node 10 being a centermost node within the volume, andnode 12 being a node outside the volume (e.g., at a distance from thevolume). The temperature may be measured at any or all of the nodes soas to construct a thermal map. In at least one embodiment, the data maybe recorded every minute, or at a different predetermined time interval.In at least one embodiment, the cubic volume 172 is established as ameasurement framework. Measurements of temperature (and measurements ofdistance from one or more of panels 10) may be taken at one or more ofthe nodes and compared, for example, to the temperature taken at thethermistor 170. In this manner, the positioning of the patient may becontrolled with respect to the illuminator to ensure that the totalacceptable light dose is achieved.

FIGS. 11A-B illustrate thermal maps according to an embodiment. FIG. 11Adepicts a thermal map of a patient's skin, prior to application of heat.Prior to application of heat, the average skin temperature was 93.6° F.In at least one embodiment, the heat source 160 may be warmed up forfive minutes, and the patient may then be exposed to light from lightsource 60 and heat from heat source 160 for about 10 minutes. FIG. 11Bdepicts a thermal map after a five-minute warm up period of the heatsource 160 and a ten minute thermal soak. After the warm-up period andten minute heat soak, the average skin temperature was 102° F. In atleast one embodiment, selected forced convection may be used, as it mayhave fewer instabilities and narrower variation in temperature over aheated target. Further, in at least one embodiment, an indirect heatapplication may be employed, such that the patient's skin does notdirectly contact the heat source 160. Rather, heat is emitted at adistance from the patient's skin, and the controller determines aproposed emission pattern based on the results of a comparison between aplurality of temperature measurements taken at nodes of the controlvolume 172 to a temperature measurement taken by thermistor 170.

In at least one embodiment, the controller may turn the heat source 160on or off through firmware that takes feedback from the temperature ofthermistor 170 and has a firmware setting of +/−1 degree. In at leastone further embodiment, a non-contact infrared (IR) sensor, such as alaser infrared sensor, may be used to detect skin temperature and supplythe sensed skin temperature data to the controller. The input from thenon-contact IR sensor may be provided in one or more maps stored in thecontroller, as further data indicative of skin temperature. In at leastone embodiment, during an initial warm-up period (e.g., five minutes),when the heat source 160 is beginning to warm up, the system is not yetat a steady state where it can be controlled to deliver a desiredoutput, but is in a transient state. The non-contact IR sensor may allowfor the patient's skin temperature to be detected and for the detectionresult to be compared to skin temperature values for a plurality ofpatients. Such skin temperature data may be data derived from a samplepopulation and stored in a map in the controller. If a given patient'sskin temperature is colder than an average skin temperature, thecontroller may accelerate heating up of the heat source 160 in order topromote warming up of the patient's skin in a more efficient manner.Alternatively, if the patient's skin temperature is comparable to orwarmer than the average skin temperature, the warm-up process may not beaccelerated, but may continue normally.

In at least one embodiment, a high skin or tissue temperature wasbetween about 40.3-42.6° C., with an average skin temperature of 41.3°C. Thermal testing was conducted with application of only light or heat,or both light and heat, at 10 mW/cm² and 20 mW/cm². Thermal testingindicated that light itself did not appear to influence the temperatureof skin on the patient's face, when the heat was on.

FIGS. 12A-D illustrate thermal data without application of light. Moreparticularly, FIG. 12A depicts a thermal map of a patient's skin ortissue temperature before heat was applied, while FIG. 12B depicts athermal map after heat was applied in a 10 minute soak. FIG. 12C showsskin temperature (thermocouple temperature) and thermistor temperaturedata for nodes 1-12. FIG. 12D depicts a plot of the thermocouple andthermistor temperature over time, during the thermal soak, for thecenter node 10.

FIGS. 13A-D illustrate thermal data without application of heat. Inparticular, FIG. 13A depicts a thermal map of a patient's skin ortissue, without applying heat. FIG. 13B depicts a thermal map followinglight treatment. FIG. 13C shows temperature data (thermocouple andthermistor data) for the center node 10. FIG. 13D depicts a plot of thethermocouple and thermistor data over time, in a treatment protocolwhere the heat source 160 was not turned on. In particular, FIG. 13Dreflects a “light-only” treatment, where there may be an elapse of apredetermined time period between when the light source is first turnedon and when the patient's skin temperature is measured. For example, aperiod of five minutes may elapse between when the light source wasfirst turned on and when the patient's skin temperature is taken, andthe patient may then receive light-only treatment for another tenminutes.

FIGS. 14A-D illustrate thermal data on a nodal basis, according to anembodiment. In particular, FIGS. 14A-D illustrate data according to anembodiment in which the patient is exposed to both light and heat duringtreatment. FIG. 14A depicts a thermal map of a patient's skin or tissuetemperature before heat treatment. FIG. 14B depicts a thermal map of apatient's skin or tissue temperature after heat treatment. FIG. 14Cdepicts temperature data, including thermocouple temperature (skintemperature) and thermistor temperature (control temperature) data atnode 10, with an irradiance density of 20 mW/cm². FIG. 14D depicts aplot of temperature data over time during a ten minute soak, at 3″ fromthe front panel (e.g., panel 10 c), with a control temperature settingof 57° C.

Additional advantages and modifications will readily occur to thoseskilled in the art. Therefore, the present invention is not limited tothe specific details and representative devices and methods, shown anddescribed herein. Accordingly, various modifications may be made withoutdeparting from the spirit and scope of the general inventive concepts asdefined by the appended claims and their equivalents.

What is claimed is:
 1. An illuminator adapted to photodynamicallydiagnose or treat a surface of a patient, comprising: a plurality ofpanels; a plurality of light sources, each mounted to one of theplurality of panels, the plurality of light sources configured toirradiate the surface of the patient with visible light; a heat sourceconfigured to emit heat to the surface of the patient between outerpanels of the plurality of panels, at least one fan configured to blowair heated by the heat source toward the surface of the patient; and acontroller programmed to control at least one of operation of (1) theheat source or (2) the at least one fan, to raise a temperature of thesurface of the patient to cause the temperature to rise by approximately2 degrees Celsius (C) to accelerate conversion of 5-aminolevulinic acid(ALA) administered to the patient.
 2. The illuminator of claim 1,wherein the heat source comprises an infrared heater having a quartzemitter.
 3. The illuminator of claim 1, wherein the plurality of lightsources are light-emitting diodes.
 4. The illuminator of claim 3,wherein at least a first one of the plurality of panels includes about80 to about 350 individual light-emitting diodes, and wherein at least asecond one of the plurality of panels includes about 50 to about 250individual light-emitting diodes.
 5. The illuminator of claim 1, whereinthe plurality of light sources are configured to emit light having awavelength from 400 nanometers to 430 nanometers.
 6. The illuminator ofclaim 5, wherein the plurality of light sources are configured to emitlight having a wavelength of 417 nanometers.
 7. The illuminator of claim1, further comprising: at least one thermistor configured to sense atemperature at the heat source.
 8. The illuminator of claim 1, whereinpower output to light sources at a perimeter of the plurality of lightsources is greater than power output to light sources at a centralregion of the plurality of light sources.
 9. The illuminator of claim 1,wherein the controller is configured to adjust an overall light dosebased on a selected treatment area.
 10. The illuminator of claim 1,wherein the controller is configured to cause the illuminator to emit alight dose based on a selected treatment time period.
 11. Theilluminator of claim 1, wherein the controller is programmed to controlthe at least one operation to cause the temperature of the surface ofthe patient to be in a range of about 40.3° C. to about 42.6° C.
 12. Theilluminator of claim 11, wherein the controller is programmed to:control warming of the heat source until a warm-up period is over; andfollowing the warm-up period, control the heat source to expose thesurface of the patient to the heated air for about 10 minutes whiledirecting the heated air toward the surface of the patient.
 13. Theilluminator of claim 1, further comprising: at least one non-contact IRsensor configured to provide sensed temperature data to the controller.14. The illuminator of claim 13, wherein the controller is programmed tocontrol the operation of the heat source to accelerate warming up of theheat source when the sensed temperature data indicates that thetemperature of the surface of the patient is colder than an average skintemperature value derived from a sample population and stored in a mapin the controller.
 15. The illuminator of claim 13, wherein: theplurality of panels include at least one panel configured to be disposedto the left of the surface of the patient and at least one panelconfigured to be disposed to the right of the surface; and at least aportion of the heat source is not obstructed by the plurality of panelsand is directly exposed to the patient.
 16. An illuminator adapted tophotodynamically diagnose or treat a surface of a patient, comprising: aplurality of panels; a plurality of light sources, each mounted to oneof the plurality of panels, the plurality of light sources configured toirradiate the surface of the patient with visible light; at least onesensor configured to detect a relative position of at least one of theplurality of panels with respect to another one of the plurality ofpanels; at least one fan configured to blow air heated by a heat sourcetoward the surface of the patient, and a controller in communicationwith the at least one sensor, the controller being programmed to controlthe light sources responsive to information from the at least one sensorso as to output visible light of uniform intensity while air heated bythe heat source is blown by the at least one fan toward the surface ofthe patient, and alter intensity of the light sources upon determining amatch between (1) information from the at least one sensor that isconfigured to detect the relative position of at least one of theplurality of panels with respect to the another one of the plurality ofpanels and (2) information designating a preset configuration of theplurality of panels with respect to one another.
 17. The illuminator ofclaim 16, wherein the controller is programmed to adjust at least one ofa light output of at least one of the plurality of light sources or aheat output of the heat source based on the detected relative position.18. The illuminator of claim 17, wherein at least some of the pluralityof panels are arranged to create a partially closed space configured toretain warm air in which the surface of the patient is immersed.
 19. Theilluminator of claim 17, further comprising one or more thermocouples,wherein the controller is programmed to reference a relationship betweena temperature measured by the one or more thermocouples and a controltemperature.
 20. The illuminator of claim 16, wherein the controller isprogrammed to control an output of at least one of the plurality oflight sources based at least on the relative position detected by thesensor and a skin temperature.
 21. The illuminator of claim 16, whereinthe at least one fan is configured to blow air heated by the heat sourcetoward the surface of the patient, which is a face of the patient, froma top and a bottom of the heat source.
 22. An illuminator adapted tophotodynamically diagnose or treat a surface of a patient, comprising: aplurality of panels; a plurality of light sources mounted to theplurality of panels, the plurality of light sources configured toirradiate the surface of the patient with visible light; a heatexchanger; at least one fan, wherein the heat exchanger and the at leastone fan are configured such that the fan moves air by the heatexchanger, such that the air moved by the heat exchanger is heated byheat exchange and directed toward the surface of the patient; and acontroller programmed to control the at least one fan to cause thetemperature of the surface of the patient to rise by approximately 2° C.to accelerate conversion of ALA administered to the patient.
 23. Anilluminator adapted to photodynamically diagnose or treat a surface of apatient, comprising: a plurality of panels; a plurality of lightsources, each mounted to one of the plurality of panels, the pluralityof light sources configured to irradiate the surface of the patient withvisible light; a heat source configured to emit heat to the surface ofthe patient between outer panels of the plurality of panels, at leastone fan configured to blow air heated by the heat source toward thesurface of the patient; and a controller programmed to control at leastone of operation of (1) the heat source or (2) the at least one fan, toraise a temperature of the surface of the patient to cause thetemperature to rise by approximately 2° C. to accelerate conversion ofALA administered to the patient, wherein the controller is configured tocontrol operation of the heat source with reference to a map correlatinga temperature value, a volumetric flow rate, and air speed to eachother.